Vitrectomy for posterior segment intraocular foreign bodies: visual results and prognostic factors

PURPOSE: To evaluate the visual results and determine the prognostic factors after the removal of retained posterior segment intraocular foreign bodies (IOFBs) by pars plana vitrectomy. METHODS: A retrospective study of 40 consecutive cases of pars plana vitrectomy for the removal of IOFBs during the period of January 1991 to June 2000 was conducted. Association between visual outcome and various preoperative, operative, and postoperative variables was statistically analyzed. RESULTS: Of the 40 cases available for the study, the IOFBs could be removed in 36 eyes. Half the patients had removal of the IOFB within 14 days of the injury. Nineteen patients (47.5%) achieved a visual acuity of 20/40 or better. Postoperative retinal detachment occurred in 13 patients (32.5%). Poor visual outcome was found to be significantly associated with poor initial visual acuity and postoperative retinal detachment, whereas good visual outcome was significantly associated with the absence of lens injury and absence of postoperative retinal detachment. CONCLUSIONS: Acceptable visual results could be achieved after the removal of posterior segment IOFBs by vitrectomy, despite a delay in surgery. Postoperative retinal detachment, poor initial visual acuity, and the absence of lens injury were the factors that played a significant role in determining the visual outcome.     

Management of endophthalmitis with retained intraocular foreign body

AIMS: To assess the impact of primary injection of intravitreal antibiotics and delayed pars plana vitrectomy with removal of intraocular foreign body (IOFB) in patients with clinical features of bacterial endophthalmitis and retained IOFB. METHODS: Retrospective review of all patients with clinical features of infective endophthalmitis and a retained IOFB who had immediate injection of intravitreal antibiotics and delayed pars plana vitrectomy with removal of IOFB in two vitreo-retinal centres during 1995-2001. Nine patients were identified and minimum follow-up was 3 months. RESULTS: Four of the nine patients had a final visual outcome of 6/18 or better. One patient developed total retinal detachment. CONCLUSIONS: The current series suggests that immediate injection of intravitreal antibiotics with delayed removal of IOFB in eyes with clinical features of infective endophthalmitis and a retained IOFB is a possible alternative to immediate removal of IOFB. This management may be associated with preservation of the eye and restoration of useful visual acuity.     

Visual outcome and prognostic factors after vitrectomy for posterior segment foreign bodies

PURPOSE: To identify the prognostic factors that predict final visual outcome in eyes with posterior segment intraocular foreign body (IOFB) injuries managed by primary pars plana vitrectomy. METHODS: Ninety-six consecutive patients with posterior segment IOFB injuries were retrospectively reviewed. Factors analyzed included initial visual acuity (VA), time between injury and presentation, site of entrance wound, uveal prolapse, vitreous prolapse, traumatized iris, endophthalmitis, location and size of IOFB, use of scleral buckling and/or an encircling band, gas tamponade, lensectomy, number of surgical procedures, and development of retinal detachment. Data were analyzed using univariate and multivariate logistic regression analysis. RESULTS: After a mean follow-up of 8.6 months, 63 eyes (65.6%) achieved VA of 20/200 or better, and 9 eyes (9.4%) had total retinal detachment complicated by inoperable proliferative vitreoretinopathy. On univariate analysis, predictors of poor vision (hand movements or less) were poor initial VA, corneoscleral entrance wound, uveal prolapse, vitreous prolapse, traumatized iris, and development of retinal detachment. In contrast, predictors of good visual outcome (20/200 or better) were absence of uveal prolapse, no endophthalmitis, and no retinal detachment. Multivariate analysis identified corneoscleral entrance wound, uveal prolapse, and development of retinal detachment as the only factors significantly associated with poor visual outcome. Absence of uveal prolapse was the only factor significantly associated with good visual outcome. CONCLUSIONS: Final visual outcome is greatly determined by the severity of the primary injury. On multivariate analysis, significant predictive factors of final VA were corneoscleral entrance wound, presence or absence of uveal prolapse, and development of retinal detachment.     

Long-term anatomical and visual outcome of vitreous surgery for retinal detachment with choroidal coloboma

CONTEXT: Vitreous surgery has been advocated as an alternative treatment of selected retinal detachments with choroidal colobomas. AIM: To study the long term anatomical and visual outcome of choroidal coloboma with retinal detachment managed by pars plana vitrectomy with silicone oil tamponade. SETTING AND DESIGN: Retrospective study conducted in a tertiary eye care hospital. MATERIALS AND METHODS: Fourty two eyes of 40 patients with retinal detachments related to coloboma of the choroid without any peripheral breaks were analyzed. All eyes underwent pars plana vitrectomy with internal tamponade using silicone oil. Endolaser was performed along the coloboma border. Silicone oil was removed in 50% of patients. The main outcome measures were retinal reattachment and visual recovery. SPSS (Statistical Package for the Social Science), version 10.0 was used for analysis. RESULTS: The retina in all cases (100%) undergoing vitrectomy were completely reattached intra-operatively. After a mean follow-up of 14 months, 37 (88.1%) eyes had attached retina. The best corrected visual acuity was 10/200 or better in 33 (78.4%) eyes. The best corrected visual acuity improved from a preoperative median of counting fingers (range 20/40 to perception of light) to median best corrected visual acuity of 20/200 (range 20/40 to perception of light) at the end of 6 months. Of the 50% (21) cases that underwent silicone oil removal, two eyes had re-detachment of retina. CONCLUSION: Pars plana vitrectomy along with silicone oil tamponade for retinal detachment related to choroidal coloboma improves the long-term anatomical and visual outcome.     

Primary silicone oil tamponade in the management of severe intraocular foreign body injuries: an 8-year follow-up

PURPOSE: To evaluate the long-term outcome of pars plana vitrectomy and primary silicone oil tamponade in patients with severe intraocular foreign body (IOFB) injuries and high risk of proliferative vitreoretinopathy (PVR). METHODS: This retrospective consecutive study included 23 patients with severe IOFB injuries who had extensive lacerations including sclera, choroid, and retina, and were complicated by predictive factors for elevated proliferative activity and an unfavorable outcome. All patients underwent pars plana vitrectomy, removal of the IOFB, and primary silicone oil tamponade and were followed up for a mean 8.9 years. Main functional outcome was assessed as final best-corrected visual acuity. Anatomic success was defined as permanent retinal attachment. RESULTS: PVR occurred in 70% of all eyes and required 16 revisions. Silicone oil was removed in 78% of the eyes after a mean tamponade duration of 9.1 months. Complete retinal attachment was achieved in 83% of the eyes. Three eyes developed a persisting hypotony that was stabilized under permanent silicone oil. Functional stabilization was observed in the third year resulting in a final visual acuity of 20/630. Useful vision of better than 20/400 could be preserved in 55% of the patients. Only one eye underwent a late enucleation after 6.8 years. CONCLUSIONS: Primary silicone oil stabilizes the retina during the critical period of active PVR and may limit the visual loss in selected high-risk eyes in the long term.     

Surgical management of non-metallic and non-magnetic metallic intraocular foreign bodies.

BACKGROUND AND OBJECTIVE: To identify clinical features and evaluate outcomes of vitreoretinal surgery in eyes with retained non-metallic and non-magnetic metallic intraocular foreign bodies (IOFBs). PATIENTS AND METHODS: Retrospective chart review. Thirty-two eyes (28 patients) with non-metallic and non-magnetic metallic IOFBs underwent removal of IOFBs with intraocular forceps, either via the pars plana in 30 eyes (93.9%) or a limbal approach in 2 eyes (6.25%). The main outcome measures were postoperative visual acuity, rate of retinal break formation, development of retinal detachment, and type of IOFB. RESULTS: IOFBs were non-metallic in 22 eyes (68.7%) and non-magnetic metallic in 10 eyes (31.1%). The average follow-up period was 7.5 months. Overall, final visual acuity was 20/40 or better in 10 eyes (31.1%) and 5/200 to 20/50 in 10 eyes (31.1%). A higher incidence of retinal break formation posterior to the sclerotomy was seen with glass IOFBs (P = .02). Retinal detachment was observed preoperatively in 4 eyes (12.5%) and postoperatively in 2 eyes (6.25%). CONCLUSION: Final visual outcome was independent of size and type of IOFB. Pars plana extractions may be associated with a higher rate of retinal break formation and subsequent retinal detachment, particularly with glass IOFBs.     

玻璃体切除术治疗急性视网膜坏死的疗效分析

目的分析玻璃体切除术治疗急性视网膜坏死的效果。方法急性视网膜坏死施行玻璃体切除术24例（24眼）。其中视网膜脱离者13例,未脱离者11例。均行常规玻璃体切除术,其中3例联合白内障手术,15例行玻璃体切除术＋硅油填充,4例单纯玻璃体切除术,2例联合巩膜外垫压。5例硅油取出后再次出现视网膜脱离,进行二次玻璃体切除＋硅油填充术。结果24例中7例术后视力较术前提高两行,8例视力无明显改善,9例术后视力继续下降。其中有5例硅油取出后出现视网膜脱离复发,再次玻璃体切除＋硅油填充术,术后视力未见明显改善。结论玻璃体切除术在治疗急性视网膜坏死长期效果差,我们期待高效抗病毒药物及有效抑制眼内免疫反应的药物能够早日在临床上应用。     

玻璃体手术治疗自发性玻璃体积血

目的观察玻璃体手术治疗非糖尿病性自发玻璃体积血的疗效及其与手术时机的关系。方法45例(46眼)非糖尿病性自发玻璃体积血行标准三通道闭合式玻璃体切除并联合眼内激光光凝等手术,并对不同时机手术的患者术后视力及并发症进行分析。结果1月以内手术者术后视力均提高。1月以上手术者14眼中术后视力提高者2眼,不变8眼,下降3眼。手术并发症主要为术中出血和医源孔及术后高眼压。术中医源孔和术后视网膜脱离均为1月以上手术者。结论玻璃体手术治疗非糖尿病性自发玻璃体浓密积血者疗效佳,并发症少。考虑玻璃体积血为视网膜裂孔所致者应及时手术。     

Combined cataract surgery and vitrectomy for recurrent retinal detachment

PURPOSE: To report our experience with combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in the management of recurrent retinal detachment (RD) and visually significant cataract. METHODS: Retrospective chart review of patients with cataract and recurrent RD who underwent combined cataract extraction, posterior chamber intraocular lens implantation, and pars plana vitrectomy between January 1991 and September 1998 at the Bascom Palmer Eye Institute. Sixteen eyes were included. All eyes had visually significant cataract and had undergone primary repair of the RD with encircling scleral buckle; eight eyes also had undergone pars plana vitrectomy during the primary repair. The technique of cataract extraction included phacoemulsification (10 eyes), extracapsular cataract extraction (5 eyes), and pars plana lensectomy (1 eye). All eyes underwent pars plana vitrectomy, membrane peeling, fluid-air exchange, endolaser treatment, and placement of a retinal tamponade. Perfluoropropane (C3F8) gas was used in 14 eyes, and silicone oil was placed in two eyes. RESULTS: The postoperative follow-up interval ranged from 4 to 64 months (mean, 16 months). Preoperative visual acuity ranged from 20/60 to hand motions and was better than 20/200 in 3 (19%) eyes. Postoperatively, 9 (56%) eyes improved to better than 20/200. Anatomic success was achieved after the initial reoperation in 13 (81 %) eyes. With further surgery, the overall success rate was 94%. CONCLUSIONS: Combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in selected patients with cataract and recurrent RD was successful in improving visual acuity and achieving retinal reattachment in most of these reoperated patients.     

双通道27G玻璃体切除术治疗硅油填充眼复发性视网膜脱离

目的:研究双通道27G玻璃体切除术在硅油填充状态下治疗复发性视网膜脱离的可行性及优缺点.方法:回顾性研究.7例硅油填充眼在随访时发现下方视网膜浅脱离.在硅油填充状态下行双通道27G玻璃体切除术.术中完成视网膜表面增殖膜剥离、视网膜下液抽吸,并在视网膜复位后行硅油下视网膜激光光凝术,根据患眼病情辅以巩膜外垫压或环扎.结果:术后所有患眼视网膜均成功复位,术中未发生严重并发症.所有患眼术后眼表反应轻且视力迅速恢复至术前水平.1眼在术后20d出现视网膜再脱离,经传统的硅油取出联合视网膜复位术成功复位视网膜.结论:双通道27G玻璃体切除术是一个治疗硅油填充眼早期视网膜再脱离的有效方法,可能具有更高的性价比.     

视力良好患者磁性眼内异物摘出方法的探讨

目的 探讨术前视力良好者不同方式经玻璃体磁性眼内异物摘出的效果.方法 46例（46只眼）磁性眼内异物者为研究对象,患眼屈光间质透明,术前矫正视力≥0.6,检眼镜下可见异物位于玻璃体腔或附着于视网膜,于伤后第2～6天手术.A组：12只眼,行导光纤维下单纯眼内异物摘出;B组：15只眼,行局限性玻璃体切除及眼内异物摘出;C组：19只眼,行玻璃体全切除及眼内异物摘出.术中进行局部视网膜光凝.结果 46例异物均顺利摘出.术后3个月：A组矫正视力均≥0.6,无视网膜脱离等并发症发生;B组13例视网膜平伏,矫正视力≥0.6,2例发生视网膜脱离;C组15例视网膜平伏,矫正视力≥0.6,4例发生视网膜脱离.结论 对于术前视力良好的磁性眼内异物,进行异物摘出时可选择导光纤维下单纯眼内异物摘出术.     

Silicone oil tamponade in 23-gauge transconjunctival sutureless vitrectomy

PURPOSE: To describe 20 consecutive patients treated with 23-gauge transconjunctival sutureless vitrectomy and silicone oil tamponade for retinal detachments (RD) of different etiologies. METHODS: Prospective case series. Twenty patients with complex retinal detachment were submitted to a primary 23-gauge transconjunctival pars plana vitrectomy: rhegmatogenous retinal detachment with proliferative vitreoretinopathy (RRD + PVR) in 7 cases, diabetic tractional retinal detachment (DTRD) in 5 cases, giant retinal tear (GRT) in 2 cases, RRD with multiple tears in 2 cases, GRT + uveitis in 1 case, RRD + uveitis in 1 case, DTRD + RRD in 1 case, and RRD + PVR with intraocular foreign body (IOFB) in 1 case. Length of postoperative follow up ranged from 3 to 14 months. RESULTS: Final visual acuity ranged from 20/25 to hand motion. Postoperatively, none of the 20 eyes had hypotony or leakage of silicone oil through the sclerotomies. Seventeen out of 20 (85%) had improved vision. CONCLUSION: Silicone oil tamponade was demonstrated to be a feasible option in conjunction with 23-g transconjunctival sutureless vitrectomy to treat complex retinal detachment.     

Management and results of retinal detachment after silicone oil removal

Of the 168 eyes undergoing silicone oil removal from 1993 to 2000, 34 developed retinal detachment after the removal of silicone oil. The management and the results of the 34 eyes were reviewed. Surgical procedures included pars plana vitrectomy, encircling band, cryocoagulation, endotamponade. Five of the 34 eyes had a second retinal detachment after these operations. One of these 5 eyes had a third retinal detachment. Final retinal reattachment was achieved in all eyes. Visual acuity decreased in 16 of the 34 eyes with retinal detachment, and 18 of the 34 eyes had a visual acuity of less than 0.02. These results show that surgery for retinal detachment after silicone oil removal yields a high rate of anatomic success, while the visual outcome is poor for a substantial number of patients.     

玻璃体切除治疗合并脉络膜脱离的黄斑裂孔性视网膜脱离疗效分析

目的探讨玻璃体切除治疗合并脉络膜脱离黄斑裂孔性视网膜脱离的临床疗效。方法对确诊为合并脉络膜脱离黄斑裂孔性视网膜脱离的48例（48只眼）随机分为应用糖皮质激素联合玻璃体切除手术组和直接行玻璃体切除手术组。对比术后视力变化、眼压、脉络膜脱离复位率、视网膜脱离复位率、黄斑裂孔状态及术后并发症等。结果经一次手术38只眼视网膜脉络膜完全复位，平均视力较术前有明显改善（P〈0．05）。术后并发症包括一过性眼压升高、晶状体混浊加剧及复位不成功等。结论对于合并脉络膜脱离的黄斑裂孔性视网膜脱离，无论术前是否应用激素，术后疗效视功能相近。术前应用糖皮质激素的必要性值得探讨。及时采取玻璃体手术是一种有效的治疗手段。     

Vitrectomy for retained lens fragments in the vitreous after phacoemulsification

PURPOSE: To assess the visual results, retinal detachment (RD) rate, incidence of glaucoma, and intraocular lens (IOL) placement after vitrectomy for removal of retained lens fragments in the vitreous after phacoemulsification. SETTING: Department of Ophthalmology, University Hospital of Lund, Lund, Sweden. METHODS: This retrospective noncomparative interventional case series included all cases of pars plana vitrectomy for removal of retained lens fragments from January 1997 through January 2000. RESULTS: Sixty-six eyes of 65 patients had pars plana vitrectomy with removal of the lens material over the 3-year period. Visual acuity on presentation was 0.1 or worse in 36 eyes (54%). Visual acuity after vitrectomy was 0.5 or better in 35 eyes (53%). The postoperative visual acuity was worse than 0.1 in 14 eyes (21%). Twenty-seven (56%) of the 48 eyes operated on within 1 week and 8 (44%) of the 18 eyes operated on later achieved a visual acuity of 0.5 or better. Twelve eyes (80%) that had secondary posterior chamber IOL implantation achieved an acuity of 0.5 or better. An RD occurred in 7 eyes (11%). CONCLUSIONS: There was no statistically significant difference in outcomes between those having vitrectomy the first few days after cataract surgery and those having it later, although there was a trend toward better results when the vitrectomy was done sooner. Secondary IOL implantation resulted in a good visual outcome. Retinal detachment was the most severe complication.     

Early vitrectomy for progressive diabetic proliferations covering the macula.

The clinical course in 50 eyes was analysed after pars plana vitrectomy for progressive diabetic fibrovascular proliferations. Patients were assigned to pars plana vitrectomy if progression of proliferations occurred despite a photocoagulation treatment with a mean number of 3500 burns and additional peripheral cryoablation. All cases had visual impairment because of fibrovascular tissue covering the macula without detachment of the macula. Flat proliferations were present in all eyes without retinal elevation, vitreous detachment, or vitreous haemorrhage. The follow up intervals ranged from 13 months to 39 months (mean interval 24 months). Twelve months postoperatively, 36 eyes (72%) showed improved visual acuity, five eyes (10%) were worse, and nine eyes (18%) were unchanged. Thirty two eyes (64%) achieved a final visual acuity of 0.2 or better, and 45 eyes (90%) gained 0.05 or better. In only two eyes could reproliferation be observed. The postoperative course indicates that pars plana vitrectomy for diabetic fibrovascular proliferations covering the macula can preserve socially useful visual acuity of at least 0.05 in most cases.     

Pars plana vitrectomy in the management of retained intravitreal lens fragments after cataract surgery

Purpose: To assess the outcome of patients who underwent pars plana vitrectomy for retained lens fragments after cataract surgery. Methods: A retrospective study of all consecutive cases with pars plana vitrectomy performed for retained lens fragment was conducted. Twenty‐seven eyes of 27 patients were included in the study. Results: Twenty‐four (89.9%) eyes received phacoemulsification. Pars plana vitrectomy was performed at the same sitting, or ranged from day 1?70 after cataract surgery. The mean follow up was 31.1 months. Final visual acuity of 6/12 or better was achieved in 15 (55.6%) patients. After excluding patients with pre‐existing eye diseases, 68.4% of patients had visual acuity 6/12 or better. Complications after pars plana vitrectomy included glaucoma (22.2%), retinal detachment (11.1%) and surgically induced necrotizing scleritis (3.7%). Conclusion: Ocular complications with poor visual outcome can occur after removal of intravitreal retained lens fragments complicating cataract surgery.     

眼内异物摘出术手术径路的选择

目的 寻求摘出眼内异物的最佳手术径路。方法 对２２例眼内异物进行回顾性研究，１２眼用传统的巩膜切开法，１０眼用经睫状体平坦部玻璃体切除术摘出异物。结果 传统方法和玻璃体切除术法均成功地摘出异物。单纯伴玻璃体出血机化者，经玻璃体手术术后视力明显提高。同时伴视网膜脱离者，异物摘出联合视网膜复位术后视力恢复不理想。结论 眼内异物摘出以不进一步损伤眼组织为原则，必须综合分析异物位置及其并发症，以选择手术路     

眼内异物伤玻璃体切除术视力预后影响因素的研究

目的探讨眼内异物伤玻璃体切除术视力预后的主要影响因素。方法参与预后分析的影响因素包括：术前视力、手术时间、伤口位置、伤口长度、异物大小、是否伤及晶状体、玻璃体积血、视网膜损伤区域、视网膜脱离共9项。对各影响因素与较好术后视力（视力≥0.5）和较差术后视力（视力〈0.1）分别进行卡方检验,然后应用多变量逻辑回归分析寻找影响预后的主要因素。结果本组眼内异物伤玻璃体切除术后69.4%术后视力≥0.1;术前较好视力和无视网膜脱离是取得术后较好视力（视力≥0.5）的重要因素;而术前视力差和出现视网膜脱离是术后视力较差（视力〈0.1）的重要因素。结论术前视力和视网膜脱离是影响眼内异物伤玻璃体切除术后视力预后最重要的因素。     

中间型葡萄膜炎并发复杂性视网膜脱离的玻璃体手术治疗

目的:探讨中间型葡萄膜炎并发复杂性视网膜脱离的临床特征及玻璃体切除联合眼内填充术的治疗效果。方法:回顾性分析我院2000-01/2005-06收治的11例(共11眼)中间型葡萄膜炎并发复杂性视网膜脱离病例术前及术后详细的临床资料。所有患者均接受巩膜外环扎,玻璃体切除联合眼内填充术治疗,术中9眼行硅油充填,2眼填充长效惰性气体。术后随访12～66mo。结果:术后11眼均获视网膜良好复位及视力增进。随访期中有7眼于6～12mo取出硅油,硅油取出后2眼因周边部PVR或葡萄膜炎复发导致视网膜脱离复发,未取硅油的4眼(包括2只再手术眼)视网膜平伏。结论:中间型葡萄膜炎并发的复杂性视网膜脱离,尤其存在周边部纤维及血管膜的牵引时,玻璃体切除联合眼内填充术效果确切,周边部PVR和葡萄膜炎复发是术后限制视网膜复位的主要原因。